Florida Medicaid Update

Beth Kidder

Deputy Secretary for Medicaid

Presented to

Medical Care Advisory Committee

August 2017

1

Medicaid Leadership Team

Deputy Secretary for Medicaid

Beth Kidder

Assistant Deputy Secretary for

Medicaid OperationsAbby Riddle

Assistant Deputy Secretary for

Medicaid Policy & Quality

Shevaun Harris

Medicaid Policy

Bureau Erica Floyd Thomas

Medicaid Quality Bureau

Marie Donnelly

Medicaid Fiscal Agent Operations

BureauGay Munyon

Medicaid Recipient and Provider

Assistance BureauDamon Rich

Medicaid Plan Management

Operations BureauEunice Medina

Assistant Deputy Secretary for

Medicaid Finance & Analytics

Dan McClary

Medicaid Program Finance Bureau

Tom Wallace

Florida Division of MedicaidJuly 2017

Medicaid Program

Coordination SectionKristin Sokoloski

Medicaid Data Analytics Bureau

Karen Chang

2

Statewide Medicaid Managed Care:

1115 Waiver

3

1115 MMA Waiver Extension Approved

• MMA program operates under the authority of an 1115

Research and Demonstration waiver.

• December 30, 2016: The Agency submitted a 5-year

extension request to federal CMS.

• August 3, 2017: Federal CMS approved the extension.

– Extension Time Period: August 3, 2017– June 30,

2022

• Includes parameters for the Low Income Pool program

4

2017-2018 Low Income Pool Provisions

• LIP is approximately $1.5 billion.

• It will not include uncompensated care for insured

individuals, bad debt, or Medicaid or CHIP “shortfall.”

– This is the same as the terms for 2016-17

• Allows expenditure of LIP funds for hospitals,

FQHCs/RHCs, and Medical School Physician practices.

• Allows additional categorization into up to four tiers

• Agency will submit a budget amendment to implement

the LIP in October 2017

Statewide Medicaid Managed Care:

Procurement for SMMC and Dental Services

6

Re-procurement of SMMC Contracts

• The ITN to re-procure SMMC health plan contracts was

released on July 14, 2017.

• We are in the statutory blackout period: “Respondents to this solicitation or persons acting on their behalf may not contact,

between the release of the solicitation and the end of the 72-hour period following

the agency posting the notice of intended award, excluding Saturdays, Sundays, and

state holidays, any employee or officer of the executive or legislative branch

concerning any aspect of this solicitation, except in writing to the procurement officer

or as provided in the solicitation documents. Violation of this provision may be

grounds for rejecting a response.” (s.287.057(23), F.S.)

• Anticipated ITN dates:

7

Activity Date

Vendor Responses Due 11/1/2017

Provider Comments Due 11/20/2017

Posting of Notice of Intent to Award 4/16/2018

Re-procurement of SMMC Contracts:

Overall ITN Structure

• 11 separate regional procurements

• One ITN per region for both Long-term Care

(LTC) and Managed Medical Assistance (MMA)

services.

• There are four plan types:

8

Type of Plan Description

Comprehensive MMA to all members, plus LTC to anyone who qualifies

LTC Plus Serves only LTC members, but provides all MMA services to them

MMA MMA only

Specialty MMA only; targeted populations

Re-procurement of SMMC Contracts:

Reaching Medicaid Goals

• The ITN was structured to require plans to demonstrate

how they can help reach the Agency reach these

Medicaid goals:

– Reduce potentially preventable hospital admissions,

readmissions, and emergency department use and

use of unnecessary ancillary services

– Improve birth outcomes

– Rebalance long-term services and supports systems

by increasing the percentage of enrollees receiving

services in the community instead of an institution

9

Re-procurement of SMMC Contracts:

Additional Enhancements

• Provider Network Enhancements

• Subcontractor Oversight

• Claims Payment Provisions

10

Procurement of the Statewide Medicaid

Prepaid Dental Program

• Currently preparing the procurement for release in the

fall of 2017.

• Program is anticipated to include:

– all state plan covered dental services.

– all eligible adults and children enrolled in Medicaid.

• Request for Information released on July 26, 2017.

– 15 responses received.

• Recipient transition to the prepaid dental program will

occur at the same time as recipient transition to the

SMMC plans awarded contracts through the SMMC re-

procurement.

11

Additional Program Updates

12

24%

34%

39%

56%58% 57%

72%

53%

43%

49%

64%66%

71%

84%

SCORES BETTER THAN THE NATIONAL AVERAGE

FOLLOW-UP AFTER HOSPITALIZATION FOR MENTAL ILLNESS 7-DAY

ANNUAL DENTAL VISIT WELL-CHILD VISITS IN THE FIRST 15 MONTHS -

6+ VISITS

LEAD SCREENING IN CHILDREN

IMMUNIZATIONS FOR ADOLESCENTS

PRENATAL CARE

Managed Care Prior to SMMC (Calendar Year 2012) SMMC Scores (Calendar Year 2016)

Represents all

scores better

than the national

average in 2012

compared to

2016.

Medicaid Managed Care (SMMC): Managed Medical Assistance

(MMA) : Examples of Improved Florida Medicaid Quality Scores

with the Implementation of SMMC

Waiver Consolidation Update

• 2017 Legislature directed the Agency to consolidate

certain waivers into the SMMC program effective

January 1, 2018:

– Project AIDS Care Waiver

– Traumatic Brain Injury and Spinal Cord Injury

– Adult Cystic Fibrosis

• No adverse impact to recipients:

– No changes in eligibility

– No changes to services

– No one will be forced into a nursing facility

14

Waiver Consolidation Update

• The Agency has conducted extensive and aggressive

outreach to stakeholders and recipients.

• Monthly webinars will continue to be held until

December:

15

Date Time Waiver(s)

August 15, 2017 2:00 – 3:00 pm PAC

August 15, 2017 3:30 - 4:30 pm TBI/SCI, ACF

September 19, 2017 2:00 – 3:00 pm PAC

September 19, 2017 3:30 - 4:30 pm TBI/SCI, ACF

October 17, 2017 2:00 – 3:00 pm PAC

October 17, 2017 3:30 - 4:30 pm TBI/SCI, ACF

November 14, 2017 2:00 – 3:00 pm PAC

November 14, 2017 3:30 - 4:30 pm TBI/SCI, ACF

December 12, 2017 2:00 – 3:00 pm PAC

December 12, 2017 3:30 - 4:30 pm TBI/SCI, ACF

PAC Webinar Series Link: https://register.gotowebinar.com/register/5247044693779038210

TBI/SCI ACF Webinar Series Link: https://register.gotowebinar.com/register/1419777758398125057

MMA Physician Incentive Program

• Florida Statute requires Medicaid health plans to

increase compensation for physicians, using funds

achieved through savings from effective care

management.

– Qualified physicians earn the Medicare rate for providing

Medicaid services.

• The Agency implemented this provision through the

MMA Physician Incentive Program.

• Year 1 of the program began October 1, 2016.

– Board Certified Pediatricians and Board Certified

OB/GYNs that met specified criteria and/or access and

quality measures were eligible for enhanced payments.

16

MMA Physician Incentive Program

• Year 2 (which begins October 1, 2017) is expanded to also

include the following, regardless of board certification:

– pediatricians

– family practitioners who serve children (under age 21)

– general practice physicians who serve children (under age

21)

• Year two is also being expanded to include board certified:

– pediatric cardiologists

– pediatric endocrinologists

– pediatric nephrologists

– pediatric neurologists

– pediatric psychiatrists

17

Statewide Medicaid Managed Care (SMMC) Recipient Complaints, since June 1, 2016 (Includes both MMA and LTC Programs)

Complaints can be reported by phone at 1-877-254-1055, oronline at https://apps.ahca.myflorida.com/smmc_cirts/

Note - The Agency has actively encouraged all stakeholders to surface any potential issue, concern, or complaint regarding the SMMC Program to the SMMC Complaint Operations Center. All allegations and issues have been

recorded, regardless of whether they were found to be accurate or substantiated.

561

516

787

651580

582598

655691

10191030

800

629

200

300

400

500

600

700

800

900

1000

1100

Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17

# of SMMC Complaints reported by Recipients to the Florida AHCA Medicaid Complaint Center - June 2016 through June 2017

SMMC

Enrollment:3,286,307 3,370,195 3,324,051 3,312,464 3,308,176 3,328,931 3,384,390 3,329,457 3,325,787 3,340,443 3,298,979 3,296,942 3,294,573

# Issues

per 1,000

Enrollees: 0.17 0.15 0.24 0.20 0.18 0.17 0.18 0.20 0.21 0.31 0.31 0.24 0.19

Statewide Medicaid Managed Care (SMMC) Provider Complaints, since June 1, 2016 (Includes both MMA and LTC Programs)

Complaints can be reported by phone at 1-877-254-1055, oronline at https://apps.ahca.myflorida.com/smmc_cirts/

Note - The Agency has actively encouraged all stakeholders to surface any potential issue, concern, or complaint regarding the SMMC Program to the SMMC Complaint Operations Center. All allegations and issues have been

recorded, regardless of whether they were found to be accurate or substantiated.

369

360

461

421

335

389

362 357

403

443

339

413403

200

250

300

350

400

450

500

Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17

# of SMMC Complaints reported by Providers to the Florida AHCA Medicaid Complaint Center - June 2016 through June 2017

SMMC

Enrollment:3,286,307 3,370,195 3,324,051 3,312,464 3,308,176 3,328,931 3,384,390 3,329,457 3,325,787 3,340,443 3,298,979 3,296,942 3,294,573

# Issues

per 1,000

Enrollees:

0.11 0.11 0.14 0.13 0.10 0.12 0.11 0.11 0.12 0.13 0.10 0.13 0.12

Prospective Payment Systems Update

20

Service ProspectivePayment System Name

Legislative Due Dates Status

Hospital Outpatient

Enhanced Ambulatory Patient Grouping (EAPG)

July 1, 2017 Implemented July 1, 2017

Nursing Home

Nursing Home Prospective Payment System(NPPS)

Summer 2017: Convene workgroup

December 1, 2017: Submit workgroup report

October 1, 2018: Implementation Date

Applications for workgroup membership are under review.

Report on Potentially Preventable Healthcare Events

21

Link to report: http://ahca.myflorida.com/Medicaid/Finance/data_analytics/BI/docs/Quarterly_SMMC_Report_Spring_2017.pdf

Questions?

22